MEMBER REGISTRATION FORM CONTACT DETAILSName* First Last Position* Council*Albury City CouncilArmidale Regional CouncilBallina Shire CouncilBalranald Shire CouncilBathurst Regional CouncilBega Valley Shire CouncilBellingen Shire CouncilBerrigan Shire CouncilBland Shire CouncilBlayney Shire CouncilBogan Shire CouncilBourke Shire CouncilBrewarrina Shire CouncilBroken Hill City CouncilByron Shire CouncilCabonne CouncilCampbelltown City CouncilCanterbury Bankstown CouncilCarrathool Shire CouncilCastlereagh-Macquarie County CouncilCentral Coast CouncilCentral Darling Shire CouncilCentral Murray County CouncilCentral Tablelands CountyCessnock City CouncilCity of Canada Bay CouncilCity of RydeClarence Valley CouncilCobar Shire CouncilCobar Water BoardCoffs Harbour City CouncilCoolamon Shire CouncilCoonamble Shire CouncilCootamundra Gundagai Regional CouncilCowra Shire CouncilDungog Shire CouncilEdwards River CouncilEurobodalla Shire CouncilFairfield City CouncilFederation CouncilForbes Shire CouncilGeorges River CouncilGilgandra ShireGlen Innes Severn CouncilGoldenfields Water County CouncilGoulburn Mulwaree CouncilGreater Hume Shire CouncilGriffith City CouncilGwydir Shire CouncilHawkesbury River County CouncilHay Shire CouncilHilltops CouncilHornsby Shire CouncilInner West CouncilInverell Shire CouncilJunee Shire CouncilKempsey Shire CouncilKu-ring-gai CouncilKyogle CouncilLachlan Shire CouncilLake Macquarie City CouncilLeeton Shire CouncilLismore City CouncilLithgow City CouncilLiverpool Plains Shire CouncilLockhart Shire CouncilMaitland City CouncilMid Coast CouncilMoree Plains Shire CouncilMosman Municipal CouncilMurray River CouncilMurrumbidgee CouncilMuswellbrook Shire CouncilNambucca Shire CouncilNarrabri Shire CouncilNarrandera Shire CouncilNarromine Shire CouncilNew England TablelandsNewcastle City CouncilNorfolk Island Regional CouncilNorth Sydney CouncilNorthern Beaches CouncilOberon CouncilPort Macquarie-Hastings CouncilPort Stephens CouncilQueanbeyan Palerang CouncilRandwick City CouncilRiverina Water County CouncilRous County CouncilShoalhaven City CouncilSingleton CouncilSnowy Valleys CouncilStrathfield CouncilSutherland Shire CouncilTamworth Regional CouncilTemora Shire CouncilTenterfield Shire CouncilTweed Shire CouncilUpper Hunter County CouncilUpper Hunter Shire CouncilUpper Lachlan Shire CouncilUpper Macquarie County CouncilUralla Shire CouncilWagga Wagga City CouncilWalcha CouncilWalgett Shire CouncilWarren Shire CouncilWarrumbungle Shire CouncilWaverley CouncilWeddin CouncilWentworth Shire CouncilWingecarribee Shire CouncilWoollahra Municipal CouncilYass Valley CouncilEmail* Phone*CONFERENCEWill you be attending both days of the conference?*Thursday 26th and Friday 27th August 2021YesNoIf not, which day will you be attending?*Thursday onlyFriday onlyWORKSHOPSPlease indicate which Workshop you would like to attend on Day 1, Thursday 26th August: WORKSHOP 1: Climate Change Risks WORKSHOP 2: Risk Culture Please indicate which Workshop you would like to attend on Day 2, Friday 27th August: WORKSHOP 3: Case Studies - Council Events WORKSHOP 4: Claims Management GENERAL MANAGERS FORUMAre you a General Manager?*YesNoIf yes, would you like to attend the General Managers Luncheon?YesNoDINNERWill you be attending the Conference Dinner?*Held on Thursday 26th August at The ICC SydneyYesNoDIETARY REQUIREMENTSDo you have any dietary requirements?*None at allGluten FreeVegetarianVeganOtherThis will be factored for both the conference catering and the dinner catering.Please outline any other dietary requirements you have and we will endeavour to address these.* PAYMENT TERMS & CONDITIONSAs a Member, your conference registration and dinner costs are covered by the Mutual. However, if cancellation notice is not received by Monday 16th August 2021, or you do not show up, you will be invoiced the full amount of $550 (inc GST) for the 2 day conference and $180 (inc GST) for the dinner.* I have read and agree to the Payment Terms & Conditions Note: In the event of a COVID outbreak in NSW and if government outlines stop us from hosting the conference you will not be invoiced.